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Delayed Adoption of New Treatments in Developing World Costs Lives

Implementation Studies Could Reduce Gap, According to NIH Scientists.

Reducing the gap between the development of new drugs and treatments and their implementation in the developing world could save thousands of lives each day and make more effective use of the U.S. investment in global health, according to scientists at the Fogarty International Center, part of the National Institutes of Health.

In a paper published in the December 14 issue of Science magazine, Fogarty’s director Roger I. Glass, M.D., Ph.D., addresses the causes of this implementation research gap and suggests ways it can be reduced. "Many evidence-based innovations fail to produce results when transferred to communities in the global south, largely because their implementation is untested, unsuitable, or incomplete," he writes. "For example, rigorous studies have shown that appropriate use of insecticide-treated bednets can prevent malaria, yet on average fewer than 10 percent of children in 28 Sub-Saharan African countries regularly sleep with this protection."

Effective implementation in resource-poor countries is an intractable problem for a number of complex reasons, according to the paper. First, scientists have been slow to view implementation as a dynamic, adaptive, multi-scale phenomenon that can be addressed through a research agenda. Second, people living in poverty face social constraints and health threats that make prevention and treatment more difficult, and are less likely to have regular access to quality care.

Even a small investment in implementation research could dramatically improve the situation, the paper suggests, as well as significantly increase the effectiveness of major U.S. investments in global health. "Instead, planners often assume that clinical research findings can be immediately translated into public health impact, simply by issuing 'one-size-fits-all' clinical guidelines or best practices without engaging in systematic study of how health outcomes vary across community settings," according to Glass.

He calls on the research community to adopt three goals to improve implementation in the developing world. First, scientists should work to advance theoretical models and new analytic methods that apply to resource-poor settings. Second, they should train a generation of researchers in interdisciplinary, systems-oriented approaches that will allow them to more effectively bridge the implementation gap. Finally, researchers should collaborate more closely with developing country governments, non-governmental organizations, and local communities.

"While implementation experiments and computational modeling may be more complex — in terms of study design and data analysis — than the monitoring and observational studies currently funded by donors, any inconvenience is outweighed by the profound ability of scientifically rigorous findings to focus limited health resources and save more lives," Glass concludes.

The Fogarty International Center, the international component of the NIH, addresses global health challenges through innovative and collaborative research and training programs and supports and advances the NIH mission through international partnerships. For more information, visit www.fic.nih.gov.

About the National Institutes of Health (NIH):
NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.